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Introduction Each year, globally, around 150 million people struggle to meet the costs of accessing and using health care and approximately 100 million people are driven below the poverty line [...], Objective To determine the nature, scope and effectiveness of interventions to reduce the household economic burden of illness or injury. Methods We systematically reviewed reports published on or before 31 January 2014 that we found in the CENTRAL, CINAHL, Econlit, Embase, MEDLINE, PreMEDLINE and PsycINFO databases. We extracted data from prospective controlled trials and assessed the risk of bias. We narratively synthesized evidence. Findings Nine of the 4330 studies checked met our inclusion criteria--seven had evaluated changes to existing health- insurance programmes and two had evaluated different modes of delivering information. The only interventions found to reduce out-of-pocket expenditure significantly were those that eliminated or substantially reduced co-payments for a given patient population. However, the reductions only represented marginal changes in the total expenditures of patients. We found no studies that had been effective in addressing broader household economic impacts--such as catastrophic health expenditure--in the disease populations investigated. Conclusion In general, interventions designed to reduce the complex household economic burden of illness and injury appear to have had little impact on household economies. We only found a few relevant studies using rigorous study designs that were conducted in defined patient populations. The studies were limited in the range of interventions tested and they evaluated only a narrow range of household economic outcomes. There is a need for method development to advance the measurement of the household economic consequences of illness and injury and facilitate the development of innovative interventions to supplement the strategies based on health insurance. Objectif Determiner la nature, la portee et l'efficacite des interventions visant a reduire la charge economique des maladies ou des blessures sur les menages. Methodes Nous avons systematiquement passe en revue les rapports publies avant le ou a Ia date du 31 janvier 2014, que nous avons trouves dans les bases de donnees CENTRAL, CINAHL, Econlit, Embase, MEDLINE, PreMEDLINE et PsycINFO. Nous avons extrait les donnees a partir d'essais controles prospectifs et evalue le risque de biais. Nous avons fait Ia synthese des donnees de maniere narrative. Resultats Parmi les 4 330 etudesexaminees, 9 d'entre elles ont satisfait nos criteres d'inclusion--7 avaient evalue les changements dans les programmes d'assurance maladie existants et 2 avaient evalue les differents modes de diffusion des informations. Les seules interventions qui reduisaient significativement les depenses restant a la charge des patients etaient celles qui eliminaient ou diminuaient substantiellement la participation aux frais pour une population de patients donnee. Toutefois, les reductions ne representaient que des changements marginaux dans l'ensemble des depenses des patients. Nous n'avons trouve aucune etude qui n'ait ete efficace dans le traitement des impacts economiques plus larges sur les menages--comme les depenses catastrophiques de sante--dans les populations de malades etudiees. Conclusion En general, les interventions visant a reduire la charge economique et complexe des maladies et des blessures sur les menages semblent n'avoir que peu d'effet sur l'economie des menages. Nous n'avons trouve qu'un petit nombre d'etudes pertinentes qui utilisaient des modeles d'etude rigoureux et qui ont ete menees sur des populations de patients definies. Les etudes ont ete limitees dans la gamme des interventions testees et elles n'ont evalue qu'une gamme restreinte de resultats economiques sur les menages. Il est necessaire de developper des methodes pour ameliorer la quantification des consequences economiques des maladies et des blessures sur les menages et pour faciliter le developpement d'interventions innovantes afin de completer les strategies reposant sur l'assurance maladie. Objetivo Determinar la naturaleza, el alcance y la eficacia de las intervenciones para reducir la carga economica familiar de enfermedades o lesiones. Metodos Se revisaron sistematicamente los informes publicados hasta el 31 de enero de 2014 (incluido) procedentes de las bases de datos CENTRAL, CINAHL, Econlit, Embase, MEDLINE, PreMEDLINE y PsycINFO. Se extrajeron los datos de ensayos controlados prospectivos y se evaluo el riesgo de sesgo. Posteriormente, se sintetizaron narrativamente las pruebas. Resultados Nueve de los 4330 estudios examinados cumplieron con los criterios de inclusion: siete habian evaluado los cambios en los programas de seguros de salud existentes, mientras que los otros dos habian evaluado modos diferentes detransmision de la informacion. Se hallo que las intervenciones que eliminabanoreduciansustancialmente los copagos para una poblacion de pacientes concreta eran las unicas que redudan el desembolso directo de forma significativa. Sin embargo, las reducciones solo representaban cambios marginalesen el gasto total de los pacientes. No se encontraron estudios que hubieran abordado con eficacia los efectos mayores en la economia familiar, como los gastos catastroficos por motivos de salud en las poblaciones de enfermedad investigadas. Conclusion En general, las intervenciones destinadas a reducir Ia complejidad de Ia carga economica familiar de enfermedades y lesiones parecen haber afectado poco a Ia economia familiar. Se encontraron pocos estudios relevantes con un diseno de estudio riguroso realizados en poblaciones de pacientes definidas. Estos estudios se limitaron a un conjunto de intervenciones probadas y unicamente evaluaban un conjunto reducido de resultados economicos para los hogares. Es necesario elaborar metodos para avanzar en la medicion de las consecuencias economicas de enfermedades y lesiones para los hogares, ademas de facilitarei desarrollo de intervenciones innovadoras a fin de complementar las estrategias basadas en seguros de salud.

An ergonomic approach could improve the quality of life and activities in daily living. Gerontechnology reduces the effects of age-related impairments with technological devices and particular design for the home-environment. Physiological decline with increasing age renders the daily activities at home more difficult. This paper highlights some 'common sense' and specific design suggestions in the entrance and kitchen, aimed to increase the self-sufficiency of elderly people. We suggest that gerontechnology may have a particular role in the improvement of comfort and safety for aged people. Keywords: Ergonomics; Gerontechnology; Home

Accidental injuries and domestic violence are among the leading causes of death and physical trauma in the United States, yet few primary caregivers advise or counsel patients on ways to prevent them. Tactful inquiries about domestic violence and supportive information can avert a worsening situation. Accident prevention counseling, ranging from home safety checklists to automobile seat belt information, can save lives and avoid injuries.

Keywords: elderly people, home environmental hazards, injuries Introduction In both the United States and Australia, injury ranks sixth as a cause of death and morbidity in older people [1, 2]. [...]

A growing awareness in the first decades of the twentieth century of the prevalence of home accidents threatened the concept of the home-as-haven and gave rise to the home safety movement. Organizationally, home safety began as part of the National Safety Council, but it never achieved the recognition accorded to industrial nor traffic safety. Increasingly, safety experts as well as society at large designated women as "home safety managers," responsible for creating a risk-free environment. The rise of home economics as a professional science for women encouraged a complementary thrust towards providing the home with the efficiency and managerial values of the factory. The development of accident statistics and the entrance of the insurance industry into the home arena helped set priorities in terms of reducing accidents. The Red Cross and the General Federation of Women's Clubs both launched campaigns against home accidents, based largely on education and admonitions of proper actions, but with only limited results. Throughout these years, women remained the socially designated responsible party, given authority roles in the home that they were often denied in the outside world. Home accident rates, however, remained high, pointing to the limitations of the strategies of the various safety organizations., "Since the dawn of history, woman has been in charge of the home and has been responsible for it. This work of home safety is peculiarly woman's work." Arvilla Miller, […]

Mothers who believe they are competent are more willing to protect their preschool children from home injury. A study of 140 low-income mothers with preschool children shows a sense of self efficacy combined with understanding health issues determines how much injury prevention effort a mother will make. Self efficacy can be improved by practicing injury prevention, modeling the desired action, using persuasion, and appealing to a mother's emotions.

Objectives. Injury is a major US public health problem, particularly in urban minority communities. This paper evaluates the impact of the Safe Block Project, a comprehensive injury prevention trial, on home hazards and injury prevention knowledge in a poor urban African-American community. Methods. Nine census tracts in the community were allocated to either the intervention area or the control area. The intervention, carried out by trained community outreach workers, consisted of (1) home modification for simple prevention measures, (2) home inspection accompanied by information about home hazards, and (3) education about selected injury prevention practices. Approximately 12 months after the intervention, random samples of control and intervention homes were assessed for home hazards and injury prevention knowledge. Results. A significantly larger proportion of intervention homes than control homes had functioning smoke detectors, syrup of ipecac, safely stored medications, and reduced electrical and tripping hazards. No consistent differences were observed between control and intervention homes on home hazards requiring major effort to correct. Conclusions. There was a distinct difference between control and intervention homes with respect to safety knowledge and home hazards requiring minimal to moderate effort to correct. The Safe Block Project could serve as a model for future urban injury prevention efforts. (Am J Public Health. 1993;83:675-680), Accidents in the home can be reduced through community-based intervention consisting of an assessment of hazards in the home and discussion of ways to alleviate the dangers. Members of the intervention team were recruited from an urban, primarily African-American neighborhood in Philadelphia, PA, and trained in injury prevention techniques. Community liaisons were responsible for ensuring community involvement in the area selected to receive safety intervention. Team members visited 3,004 homes and pointed out potential hazard areas to residents. They also provided minor safety remedies such as bath thermometers to prevent scalds, batteries for smoke detectors and syrup of ipecac as a remedy for accidental poisoning. Follow-up in the homes found that homes that received intervention were more likely to have corrected potential safety hazards that required minimal to moderate intervention. Residents also had better knowledge of home injury prevention.

ICE Ergonomics Ltd was commissioned to carry out an ergonomics appraisal of a selection of products for elderly people. The products chosen were 28 non-prescription items which were commercially available to the general public through retail outlets and marketed as aids to daily living for older members of the population. The survey included analysis of accident data from the Home Accident Surveillance System (HASS), and an expert appraisal of the products, taking into account safety, function and quality. The findings showed that many of these products were inappropriate or inadequate to perform the tasks for which they were intended. Some were of poor quality and could introduce hazards to a home environment. The paper highlights some of the products that were found to be unsuitable for older consumers. A list of references and ICE reports used during the study is given in the bibliography at the end of the paper.

Home safety education may reduce the number of accidents that occur in the home among children of adolescent mothers. A study examined the number of injuries that had occurred among children of 363 adolescent mothers during the first 15 months of life. Nineteen percent of the children had injuries requiring medical attention, and 14% had injuries requiring hospitalization. Fifty-three percent of the injuries were caused by falls and 30% of the injuries were burns. Children whose mothers had received instruction on home safety by three months postpartum were less likely to be injured than those whose mothers had not received instruction. Children of mothers who received information from many sources were less likely to be injured. Different sources of information included health care professionals, teachers, parents and other family members., The purpose of this study was to describe the epidemiology of injuries in children of adolescent mothers (

This study evaluated the use of written checklists and task analyses as self-administered prompts to teach home accident prevention skills to 4 adults with brain injuries. Subsequent to baseline, participants used written checklists that identified potential in-home hazards but did not prompt behaviors necessary for hazard remediation. Written individualized task analyses, incorporating specific behavioral steps for correcting hazards that participants had failed to remediate during the checklist phase, were used to prompt appropriate responding when necessary. These were subsequently faded to transfer stimulus control to the natural conditions. A multiple probe technique across participants and settings was used. Results indicated that the checklist alone was sufficient to increase appropriate responses to many of the potential hazards. Generalization to untrained potential hazards occurred to some degree for all participants. Follow-up results showed that most skills trained were maintained over a 1-month period. DESCRIPTORS: safety, brain injury, self-instruction, prompting, multiple probe technique